LOWER GI
Irritable Bowel Syndrome:
• Usually involves the large bowel
• Characterized by chronic abd. pain & alt. of bowel paerns
o Abd. distention
o Nausea
o Excessive flatulence
o Bloating
o Mucus in stool
o Urgency
o Sensation of incomplete evacuation
o Fatigue
o Sleep disturbances
o Headache
• Cause is unknown
o May be d/t psychological stress
o More common in women
• Diagnosis à hx, stress & anxiety, allergies
o Characteristic symptoms
o Other conditions are ruled out
o Symptom based criteria
§ Abd. pain/discomfort at least one day per week for 3 month with 2 of the following
• Related to defecation
• Change in stool frequency
• Change in stool form
• Treatment:
o Dealing w psychological factors
o Keeping a diary of symptoms, diet, & episodes of stress
o Participating in regular exercise
o Follow low FODMAP diet
o Avoid gas-producing foods à broccoli & cabbage
o Probiotics à improves symptoms
o If constipation is a problem à increase fiber
, • Medications:
o Dicyclomine à antispasmodic agent may be tried
o Loperamide à may be effective if diarrhea is present
o Lubiprostone à if constipation is present (women)
o Linaclotide à if constipation (men or women)
Appendicitis:
• Inflammation of the appendix
• Occurs in 7% of the population
o Most common in 3-10 years of age
• Pathophysiology:
o Obstruction of lumen d/t accumulation of feces
o Results in distention, venous engorgement & accumulation of mucus & bacteria
§ Can lead to gangrene & perforation
• Diagnosis:
o H&P
o Differential WBC count
o Urinalysis
o CT scan à gold standard
o Ultrasound
o MRI
• Etiology:
o Obstruction of lumen by…
§ Feces
§ Foreign bodies
§ Tumor
§ Intramural thickening
• Clinical manifestations:
o Beings w periumbilical pain
o Anorexia
o N/V
o Pain is persistent
o Pain shifts to McBurney's point
o Localized tenderness
o Rebound tenderness à pain w removal of pressure
o Muscle guarding
o May have low grade fever
o Rovsing's signs à pain elicited by LLQ & pain with RLQ
o Pain with coughing & sneezing
• Treatment:
o NPO
o Monitor VS
o IV fluids
o Provide comfort
o Measures à p! & nausea meds
o Antibiotics
Irritable Bowel Syndrome:
• Usually involves the large bowel
• Characterized by chronic abd. pain & alt. of bowel paerns
o Abd. distention
o Nausea
o Excessive flatulence
o Bloating
o Mucus in stool
o Urgency
o Sensation of incomplete evacuation
o Fatigue
o Sleep disturbances
o Headache
• Cause is unknown
o May be d/t psychological stress
o More common in women
• Diagnosis à hx, stress & anxiety, allergies
o Characteristic symptoms
o Other conditions are ruled out
o Symptom based criteria
§ Abd. pain/discomfort at least one day per week for 3 month with 2 of the following
• Related to defecation
• Change in stool frequency
• Change in stool form
• Treatment:
o Dealing w psychological factors
o Keeping a diary of symptoms, diet, & episodes of stress
o Participating in regular exercise
o Follow low FODMAP diet
o Avoid gas-producing foods à broccoli & cabbage
o Probiotics à improves symptoms
o If constipation is a problem à increase fiber
, • Medications:
o Dicyclomine à antispasmodic agent may be tried
o Loperamide à may be effective if diarrhea is present
o Lubiprostone à if constipation is present (women)
o Linaclotide à if constipation (men or women)
Appendicitis:
• Inflammation of the appendix
• Occurs in 7% of the population
o Most common in 3-10 years of age
• Pathophysiology:
o Obstruction of lumen d/t accumulation of feces
o Results in distention, venous engorgement & accumulation of mucus & bacteria
§ Can lead to gangrene & perforation
• Diagnosis:
o H&P
o Differential WBC count
o Urinalysis
o CT scan à gold standard
o Ultrasound
o MRI
• Etiology:
o Obstruction of lumen by…
§ Feces
§ Foreign bodies
§ Tumor
§ Intramural thickening
• Clinical manifestations:
o Beings w periumbilical pain
o Anorexia
o N/V
o Pain is persistent
o Pain shifts to McBurney's point
o Localized tenderness
o Rebound tenderness à pain w removal of pressure
o Muscle guarding
o May have low grade fever
o Rovsing's signs à pain elicited by LLQ & pain with RLQ
o Pain with coughing & sneezing
• Treatment:
o NPO
o Monitor VS
o IV fluids
o Provide comfort
o Measures à p! & nausea meds
o Antibiotics
